Fractures of the trapezium are rare and are usually treated by open reduction and internal fixation. The trapeziometacarpal joint is difficult to visualize with standard radiographic techniques; proper visualization of the joint surface of the scaphometacarpal and trapeziometacarpal joints is paramount. A 36-year-old male patient complained of isolated wrist pain and had limitation of wrist function after a motor vehicle accident. The injury was closed without obvious deformity. Radiographs showed a longitudinal shear fracture of the trapezium. Five days later, the patient was taken to surgery, and with standard wrist arthroscopy, a 1.9-mm arthroscope was inserted via the radial carpometacarpal (CMC) portal into the CMC joint. A probe was inserted via the ulnar CMC to manipulate and reduce the fragment. A bone clamp achieved reduction, and 0.035-inch K-wires provisionally stabilized the fragments. Compressive fixation was accomplished with a percutaneous mini Acutrak headless screw (Acumed, Hillsboro, OR). A thumb spica splint was placed for 3 weeks, and, subsequently, progressive mobilization and strengthening was provided. At 6 weeks, union, normal range of motion, and full strength were present, and at 18 months, the patient returned to his previous level of activity with an excellent outcome. Arthroscopy provides direct visualization and accurate restoration of articular congruity, yielding excellent results.